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General NPI Number Information
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NPI Number | 1912316811
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Entity Type | Organization
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Legal Business Name | GREAT PLAINS DIABETES RESEARCH, INC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 834 N SOCORA ST SUITE 4
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City | WICHITA
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State | KS
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Zip | 67212
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Country | US
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Telephone | 316-440-2802
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Fax | 316-440-2809
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Provider Business Mailing Address
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Address Line | 834 N SOCORA ST SUITE 4
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City | WICHITA
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State | KS
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Zip | 67212-3279
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Country | US
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Telephone | 316-440-2802
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Fax | 316-440-2809
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RITA PEDIGO
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Credential |
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Telephone | 316-440-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 74249
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License Number State | KS
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